DELAFIELD 


introductory  Address 


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INTKODUCTORY  ADDRESS 


STUDENTS   IN   MEDICINE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


UNIVERSITY 


OF    THE  STATE   OF   NEW-YORK. 


Delivered  Nov.  7,  1837, 


BY  EDWARD  DELAFIELD,  M.  D., 

PROFESSOR   OF    OBSTETRICS,   AND  THE   DISEASES  OF    WOMEN   AND    CHILDREN. 


NEW-YORK: 

PUBLISHED   BY    THE   STUDENTS 
1837. 


Scatcherd  and  Adams,  Printers 


0& 


INTRODUCTORY  ADDRESS 


STUDENTS   IN   MEDICINE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


UNIVERSITY 


OF    THE  STATE   OF   NEW-YORK. 


Delivered  Nov.  7,  183T. 


BY  EDWARD  DELAFIELD,  M.  D., 

PROFESSOR   OF   OBSTETRICS,   AND   THE    DISEASES   OF   WOMEN   AND   CHILDREN. 


NEW-YORK: 

PUBLISHED   BY   THE  STUDENTS. 

1837. 


iJfr-WECECTlON 


M'atiO'DLKCTION 


Niw-York: 

Printed  by  Scatchkrd  &c  Adams, 

No.  38  Gold  Street 


College  of  Physicians  and  Surgeons. 

New-York,  November  10th,  1837. 
Sjr, 

At  a  meeting  of  the  students  of  this  college,  held  on  the  9th  inst.  it  was 
unanimously  resolved  that  a  committee  of  five,  with  the  addition  of  the  chair- 
man and  secretary,  be  appointed  respectfully  to  request  a  copy  of  your  very 
able  and  appropriate  introductory  address,  for  publication.  Believing  that  it 
points  out  a  course  of  study  which,  if  diligently  pursued,  will  not  only  guide 
the  student  to  eminence  in  his  profession,  but  will  also  tend  to  elevate  and  add 
dignity  to  that  profession  to  which  we  intend  to  devote  our  lives,  and  at  the 
head  of  which  your  talents  and  assiduity  have  deservedly  placed  you, — 

We,  a  committee  appointed  for  this  purpose,  take  great  pleasure  in  joining 
our  fellow-students  in  this  request. 
We  are,  Sir, 

Yours,  with  much  respect, 

W.  De  S.  BOWEN,  -^ 

T.  M.  HALSTEAD, 

Wm.  COCKCROFT, 

H.  D.  PAINE,  [committee. 

T.  F.  COCK, 

Wm.  G.  EADIE,  Chairman, 

T.  M.  MARKOE,  Secretary.^ 

To  Professor  Edward  Delafield. 


Gentlemen, 

The  Lecture,  a  copy  of  which  you  have  done  me  the  honor  to  request  for 
publication,  was  not  intended  for  any  greater  degree  of  publicity  than  it  has 
already  received.  A  treatise  on  Medical  Education  can  by  no  means  be  com- 
pressed within  the  limits  of  an  introductory  discourse,  if  it  aim  at  giving  a 
complete  view  of  this  important  subject.  In  complying  with  your  wishes,  then, 
gentlemen,  I  do  so,  not  because  I  think  the  lecture  worthy  of  your  acceptance, 
but  that  I  may  not  appear  ungrateful  for  the  kindness  which  dictated  your  flat- 
tering request.  With  the  highest  interest  in  your  welfare,  and  that  of  the  class 
you  represent, 

I  am,  Gentlemen, 

Your  obedient  Servant, 

EDWARD  DELAFIELD. 
No.  9  Warren  Street,  Nov.  10th,  1837. 

To  Messrs.  W.  De  S.  BOWEN, 
T.  M.  HALSTEAD, 
Wm.  COCKCROFT, 
H.  D.  PAINE,  y Committee. 

T.  F.  COCK, 
Wm.  G.  EADIE,  Chairman, 
T.  M.  MARKOE,  Secretary.) 


INTRODUCTORY  LECTURE 


MEDICAL  EDUCATION. 

Gentlemen, 

You  are  assembled  here  with  one  common  ob- 
ject,— the  acquisition  of  medical  knowledge.  By  the 
possession  of  this  knowledge,  you  hope  to  be  enabled, 
at  a  future  day,  to  practise  with  success  one  of  the 
most  honorable  and  useful  professions  ;  to  acquire  to 
yourselves  reputation ;  to  gain  rank  in  society  and 
consideration  among  your  fellow-citizens ;  it  may  be, 
to  obtain  wealth,  or  at  least  a  comfortable  subsist- 
ence ;  and,  above  all,  to  relieve  human  suffering  and 
prolong  human  life. 

Many  of  you  are  only  now  beginning  your  profes- 
sional studies,  and  to  such  especially  I  would  address 
myself.  Have  you  sufficiently  reflected  upon  the  ne- 
cessity of  pursuing  a  right  method  in  your  medical 
education  ?  It  is  to  be  feared  that  there  is  not  among 
us  sufficient  pains  taken  to  pursue  the  study  of  medi- 


cine  in  such  an  order  as  to  acquire  the  greatest 
amount  of  knowledge  with  the  least  waste  of  time. 
It  is  probable  that  many  students  do  not  take  from 
those  more  experienced  than  themselves  proper  direc- 
tion on  this  subject ;  and  that  they  allow  accident  and 
circumstances  to  regulate  what  should  be  the  result 
of  pre-determined  order  and  method.  There  may  be 
some  among  you  who  engage  in  your  studies  somewhat 
like  the  visiter  to  a  great  library,  who,  without  cata- 
logue and  without  guide,  takes  at  random  books  from 
the  shelves  ;  and  expects  by  their  perusal  to  become 
a  learned  man. 

It  must  be  acknowledged  that  there  is  generally,  in 
this  country,  a  want  of  system  in  medical  education  ; 
and  it  is  almost  to  be  desired  that  the  subject  should  be 
distinctly  taught  by  a  separate  teacher,  as  in  several 
of  the  German  universities,  where  Professorships  ex- 
ist devoted  to  this  object,  in  connexion  with  medical 
Bibliography. 

The  most  striking  defect  in  medical  education,  as 
pursued  among  us,  is  the  shortness  of  the  time  devot- 
ed to  it.  I  believe  in  no  State  of  the  Union  is  a  term 
of  more  than  three  years'  medical  study  required, 
and  in  some  only  two  years.  At  the  early  age  of 
twenty-one,  and  after  this  brief  period  of  study,  do  a 
large  number  of  gentlemen  every  year  present  them- 


selves  as  candidates  for  public  favor  in  the  practice 
of  medicine. 

This  proneness  to  premature  efforts  in  the  business 
of  life  is  peculiar  to  our  country  in  every  avocation 
and  profession  ;  and  in  each  and  every  one,  more  or 
less  injury  to  individuals  is  the  result.  But  especial- 
ly in  our  profession,  where  human  life  is  constantly 
placed  in  our  hands ;  and  where  upon  our  knowledge 
and  skill  depends  the  amount  of  pain  and  suffering 
which  is  to  be  endured  by  those  who  call  upon  us  for 
professional  aid,  is  incompetent  knowledge  most  to 
be  deprecated.  And  it  is  hazarding  little  to  say, 
that  in  this  short  time  very  few,  if  any,  young  men 
can  render  themselves  so  far  masters  of  their  profes- 
sion, as  to  practise  it  with  any  degree  of  confidence 
or  success. 

Nor  is  any  thing  gained  by  those  who  thus  early 
come  forward.  All  experience  has  proved  that  men 
who  do  not  thus  early  rush  forward  into  life  half 
prepared,  but  are  content  patiently  and  diligently 
to  apply  themselves  as  students  for  a  longer  period, 
succeed  more  completely  in  the  end ;  and  that  at  the 
age  of  thirty,  the  physician,  who  commenced  his  ca- 
reer at  twenty-five,  will  be  in  advance  of  him  who 
began  at  twenty-one. 

Be  not  content,  then,  with  merely  that  amount  of 


8 

medical  knowledge  which  the  law  requires.  Recol- 
lect that  the  possession  of  a.  medical  diploma  does 
not  imbue  its  holder  with  medical  knowledge ;  and 
that  the  mere  fact  of  having  complied  with  the  re- 
quisitions of  law,  and  obtained  a  license  to  practise, 
does  not  prove  to  your  friends,  and  those  whose  pa- 
tronage you  seek,  that  you  are  to  be  trusted  in  the 
management  of  their  diseases. 

It  is  true  that  none  of  us  can  cease  to  be  students 
in  fact,  when  the  period  of  our  pupilage  is  completed. 
We  must  all,  while  in  actual  practice,  learn  by 
constant  observation  and  experience  what  we  can 
acquire  in  no  other  way ;  but  it  is  equally  certain 
there  are  many  things,  which,  if  you  do  not  acquire 
now,  you  will  never  again  have  an  opportunity  of 
learning.  Of  some  you  may  now  become  complete- 
ly masters  ;  and  in  default  of  present  study,  you  will 
always  remain  in  ignorance  of  them  ;  while  of  others 
you  can  only  acquire  the  outline  and  principle.  You 
may  make  a  sketch,  which  at  a  future  period,  and  by 
careful  observation  and  study,  you  may  fill  up. 

Where  again,  in  after-life,  will  you  have  opportu- 
nities of  learning  Anatomy  and  Physiology  by  actual 
demonstrations  and  dissections  ?  If  you  do  not,  as 
students,  make  yourselves  well  acquainted  with  the 
healthy  structure  and  functions  of  the  human  body, 


is  it  probable  that  you  will  ever  be  thoroughly  instruct- 
ed in  these  most  essential  branches  of  our  science  1 
And  if  these,  the  foundation  of  all  medical  knowledge, 
be  imperfectly  known,  how  can  you  raise  the  super- 
structure of  practical  science,  which  is  to  enable  you 
hereafter  to  fulfil  the  duties  of  your  profession  1  And 
in  Morbid  Anatomy,  you  now  have  an  opportunity, 
afforded  by  extensive  collections  of  preparations  show- 
ing the  effect  of  disease  upon  the  human  body,  the 
result  of  the  labor  of  years  in  their  accumulation,  to 
become  well  acquainted  with  this  most  instructive 
subject.  If,  then,  you  do  not  now  avail  yourselves  of 
these  opportunities,  how,  at  any  future  time,  in  the 
midst  of  practice,  and  perhaps  in  situations  far  dis- 
tant from  schools  of  medicine,  will  you  acquire  this 
knowledge  1 

Use  then,  gentlemen,  diligently  the  time  and  op- 
portunities which  now  present  themselves ;  and  in 
proportion  as  you  do  so,  will  you  find  straight  and 
easy  the  path  of  science  in  which  you  intend  to 
walk. 

In  enumerating  the  different  branches  of  know- 
ledge which  the  accomplished  physician  ought  to 
possess,  if  we  were  to  omit  nothing,  there  is  hardly 
any  department,  either  of  science  or  literature,  which 
might  not  be  placed  in  the  list.    It  is  not  uncommon^ 

2 


10 


upon  occasions  like  the  present,  for  men  of  every 
profession  to  exaggerate  the  amount  of  preparatory 
study  necessary  for  those  who  intend  to  engage  in 
its  practice  ;  and  such  an  array  of  science  is  some- 
times brought  forward  as  essential  to  be  learned,  as 
is  sufficient  to  intimidate  those  who  are  commencing 
their  course  of  study.  And,  indeed,  it  is  true  that  the 
physician  must  have  a  certain  degree  of  acquaintance 
with  a  great  variety  of  subjects.  But  it  is  not  possi- 
ble, nor  is  it  necessary,  that  each  one  should- be  pur- 
sued to  its  utmost  extent,  as  if  that  alone  were  to  be 
the  business  of  our  lives.  It  is  acknowledged,  on  all 
hands,  that  Anatomy  is  essential  to  every  physician ; 
but  how  far  must  it  be  studied  ?  Haller  estimated 
the  time  necessary  for  the  acquisition  of  this  science 
at  twenty  years  of  one's  life  ;  and  no  one  better  than 
Haller  could  judge  what  is  necessary  for  an  Anato- 
mist.* Nobody  would  pretend,  that  to  become  a  good 
physician  or  surgeon,  we  must  study  Anatomy  in  this 
manner.  We  all  know,  that  without  a  knowledge  of, 
Chemistry  we  cannot  understand  the  nature  or  proper 
mode  of  preparing  and  administering  the  various  ar- 
ticles of  the  Materia  Medica;  and  yet  to  become 
masters  of  this  science,  many  men  devote  their  lives, 

*  Dr.  Latham,  Med.  Gazette.    Vol.  XIII.  page  344. 


11 

and  find  all  their  time  none  too  much  for  what  they 
would  learn. 

It  is  not  thus  that  the  student  of  medicine  must 
study.  He  must  not  become  an  enthusiast  in  the 
pursuit  of  any  of  the  sciences  which  are  only  subsi- 
diary to  the  profession.  He  must  give  each  its  just 
and  proper  degree  of  attention  ;  not  allowing  himself 
to  be  diverted,  by  excessive  fondness  for  any  one  of 
them,  from  the  more  essential  pursuits  which  bear 
upon  the  practice  of  the  profession.  All  experience 
has  shown  that  this  kind  of  indulgence  is  sure  to  pre- 
vent success  in  the  practice  of  medicine.  He  who  de- 
votes the  largest  portion  of  his  time  to  chemistry,  or 
to  geology,  botany,  or  any  other  branch  of  natural 
history,  is  in  imminent  danger  of  being  led  away 
from  the  more  direct  objects  of  a  physician's  pur- 
suit. 

It  is  not  so,  however,  with  those  branches  of  our 
science  which  are  more  immediately  connected  with 
practice.  In  acquiring  these,  it  is  desirable  that  we 
should  have  enthusiasm.  There  must  be  zeal,  there 
must  be  ardour,  in  pursuing  our  studies,  as  they  con- 
duce to  the  one  great  object  of  making  us  good  phy- 
sicians ;  and  the  more  completely  the  pursuit  of  pro- 
fessional knowledge  becomes  a  passion,  the  more  cer- 
tainly we  arrive  at  great  success  in  its  acquisition. 


With  this  view,  it  has  always  been  found  most  desir- 
able for  every  student,  after  he  has  acquired  a  good 
general  knowledge  of  the  whole  subject,  to  attach 
himself  to  one  particular  department  of  medicine,  in 
which  he  will  aim  at  acquiring  especial  skill  and 
especial  eminence.     It  is  impossible  for  any  one  man 
to  become  thoroughly  master  of  every  subject  in  me- 
dicine  and   surgery ;    and   those   who   attempt  all 
equally,  arrive  at  no  remarkable   success   in   any. 
They  may  become  respectable  practitioners  of  physic, 
but  will  never  reach  the  first  rank  of  the  profession. 
The  majority  of  students,  whatever  may  be  their  pur- 
suits eventually,  are,  in  the  first  instance,  so  much 
captivated  by  the  showiness  of  surgical  operations, 
and  carried  away  by  the  reputation  which  uniformly 
follows  great  skill  in  these  operations,  that  they  de- 
vote themselves  too  exclusively  to  this  subject.     But 
when  you  look  around  this  great  city,  and  observe 
how  small  a  number  of  our  profession  have  acquired 
great  reputation  in  operative  surgery,  and  how  large 
a  mass  are  daily  engaged  in  the  treatment  of  diseases 
requiring  no  operation,  you  will  easily  discover  that 
this  field  can  be  occupied  by  a  very  small  number. 
But  if  every  medical  man  cannot  become  a  great 
surgeon,  he  can  at  least  make  himself  master  of 
some  one  department  of  his  profession  ;  and  the  skill 


13 

he  will  acquire  in  this  branch,  by  enabling  him  oc- 
casionally to  effect  cures  in  cases  where  others  fail, 
cannot  but  give  him  a  reputation  which  will  extend 
to  every  other  part  of  his  employment.  It  is  in  this 
way,  too,  that  you  may  hope  to  improve  as  well  as 
practise  your  profession  ;  that  you  may  more  tho- 
roughly ascertain  the  nature  of  certain  diseases,  and 
devise  more  successful  modes  of  treatment  than  those 
who  have  preceded  you  :  and  thus,  by  your  writings, 
may  acquire  fame  which  will  endure  after  yourselves 
have  passed  away.  Inquire  into  the  history  of  emi- 
nent medical  men  of  every  age  and  country,  and  you 
will  generally  find  that  some  one  subject,  at  least  at 
first,  had  engaged  them  more  than  all  the  rest ;  and 
that  to  a  remarkable  skill  in  treating  one  class  of 
diseases,  has  much  of  their  general  reputation  been 
attributable. 

Not,  however,  that  I  would  urge  you,  in  pursuing 
one  branch  of  medicine,  to  neglect  the  rest.  The 
mere  practitioner  in  a  single  class  of  diseases  is  very 
apt  to  degenerate  into  the  charlatan.  We  cannot 
treat  any  one  disease  well,  unless  we  are  generally 
acquainted  with  the  other  maladies  to  which  the  hu- 
man body  is  subject :  and  the  history  of  medicine  has 
fully  shown,  that  little  has  been  done  for  our  science 
by  those  who  practise  single  branches  to  the  exclu- 


14 

sion  of  all  the  rest.  The  connexion  between  the  dif- 
ferent parts  of  the  human  body  is  too  intimate,  and 
the  symptoms  of  many  diseases  too  varied  and  multi- 
form, to  allow  us  to  understand  any  one  exclusively. 
Become,  then,  good  general  practitioners,  so  as  to  be 
prepared  for  any  emergency  in  which  you  may  be 
placed ;  but  in  some  one  department,  be  especially 
strong.  Let  this  be  your  favorite  pursuit ;  the  one 
in  which  you  will  endeavour,  at  least,  to  excel  all 
others ;  and  if  you  do  not  attain  this  result,  you  may 
at  least  be  behind  few. 

In  pursuance  of  this  object  there  is  no  means  bet- 
ter calculated  to  ensure  its  attainment,  than  to  pre- 
pare yourselves  to  become  teachers  of  the  branch  of 
medicine  to  which  you  attach  yourselves.  You  can- 
not be  more  usefully  employed,  when  you  have  finish- 
ed your  course  as  students  of  medicine,  than  in  pre- 
paring lectures  on  some  medical  subject;  and  even  if 
these  lectures  are  never  heard  by  an  audience,  the 
labor  you  have  bestowed  upon  them  will  be  abun- 
dantly repaid  by  the  more  accurate  and  extensive 
knowledge  you  will  have  acquired.  It  is,  indeed, 
much  to  be  desired,  that  a  greater  number  of  private 
courses  of  lectures  should  be  given  in  this  city.  The 
number  of  those  who  in  this  way  prepare  themselves 
for  becoming  public  teachers  is  by  no  means  great ; 


15 

while  the  demand  for  them  in  the  constantly  forming 
new  medical  schools,  is  incessant ;  and  to  the  cities 
especially  are  inquiries  directed  for  filling  such 
places. 

Having  made  these  general  remarks  upon  the 
modes  of  acquiring  professional  knowledge,  let  me 
next  direct  your  attention  to  the  different  subjects  you 
must  learn,  and  the  proper  order  for  pursuing  their 
study. 

The  preliminary  education  of  students  of  medicine 
is  of  no  small  importance  ;  and,  in  consequence  of  de- 
ficiency here,  may  too  many  industrious  pupils  find 
themselves  constantly  impeded  in  their  more  immedi- 
ately professional  studies.  It  is  highly  desirable 
that  every  student,  before  he  commences  the  study 
of  medicine,  should  have  obtained,  at  least,  the 
amount  of  knowledge  which  is  usually  taught  in  our 
colleges.  But  it  need  be  no  discouragement  to  those 
who  have  not  had  this  advantage ;  if  they  will  still 
make  the  best  use  of  their  time,  and  not  be  too  anx- 
ious early  to  enter  the  profession.  They  may,  in 
fact,  acquire  all  that  is  most  essential,  even  while 
they  are  pursuing  the  study  of  medicine ;  and  by 
greater  diligence,  acquire  as  much,  and  often  more, 
than  those  who  have  had  superior  advantages.  The 
amount  of  knowledge  we  may  gain  on  any  one  sub- 


16 

ject,  by  severe  application  for  even  a  very  small  por= 
tion  of  each  day,  is  almost  incalculable  ;  and  if  you 
will  make  the  experiment,  you  will  find  that,  with- 
out neglecting  your  professional  studies,  you  may 
still  make  up  for  any  deficiency  in  your  previous 
education. 

Of  these  preliminary  studies,  the  classical  lan- 
guages are  among  the  first  to  engage  the  student's 
attention.  Without  a  competent  knowledge,  at  least 
of  Latin,  no  physician  can  make  any  pretensions  to 
learning  in  his  profession.  It  is  the  universal  lan- 
guage of  science,  from  which  are  taken  most  of  the 
technical  terms  and  phrases  which  are  commonly 
employed  in  medicine.  It  is  the  medium  through 
which,  even  still,  those  who  would  write  for  the 
whole  world,  and  not  merely  for  their  own  nation, 
convey  to  the  learned  of  other  countries  their  im- 
provements and  discoveries  in  science.  It  is  true 
that  we  have  all  known  good  and  excellent  physi- 
cians who  knew  nothing  of  Latin  or  Greek  ;  but  we 
have  never  known  one  such  who  did  not  most  deep- 
ly regret  his  ignorance  of  these  languages,  and 
constantly  feel  it  a  clog  and  impediment  in  prosecu- 
ting his  medical  studies. 

I  need  not  spend  much  time  in  dwelling  upon 
the  advantage  of  understanding  also  several  modern 


17 

languages.  French  is  now  so  common,  that  no  man 
is  considered  as  well-educated  without  it ;  and  a 
physician  who  cannot  at  least  read  this  language,  is 
cut  off  from  the  perusal  of  many  of  the  most  valua- 
ble works  on  medicine  and  surgery  which  have  been 
written. 

Next  to  French,  it  is  desirable  also  to  learn  the 
German  language.  No  nation  is  in  advance  of  Ger- 
many in  all  knowledge,  directly  or  indirectly  connect- 
ed with  medicine;  and  in  no  language  are  there 
published  so  many  valuable  works  of  our  science. 
Add  to  this  the  extraordinary  industry  of  German 
authors  in  collecting  together  every  thing  which  is 
published  in  other  languages,  and  immediately  trans- 
lating it  into  their  own  ;  and  we  perceive  that  it  is 
thus  made  an  almost  universal  medium  in  which  may 
be  found  the  science  of  all  the  rest  of  the  world. 

But  the  study  of  languages,  both  ancient  and  mo- 
dern, should  not  be  recommended  on  the  ground  of 
immediate  utility  alone.  "  Not  only  are  these  ac- 
complishments required  for  the  full  understanding  of 
the  matters  proper  to  our  science  ;  they  elevate,  also, 
and  dignify  its  character — throw  a  grace  and  charm 
around  its  pursuit,  and  by  exercising  the  mental 
faculties,  invigorate  them  for  the  more  ready  appre- 
hension of  the  truth."* 

*  Dr.  Watson,  Med.  Gazette.  Vol.  XIII.  page  3. 


18 


It  would  hardly  appear  necessary  to  urge  upon 
those  who  are  studying  a  liberal  profession,  that  while 
they  are  devoting  time  and  labor  to  the  acquisition 
of  foreign  languages,  both  ancient  and  modern,  they 
should  not  neglect  their  own  mother  tongue.     But  it 
is  to  be  feared  there  are  few  subjects  which  less  en- 
gage the  attention  of  students  of  medicine.     Of  this 
the  Professors  of  a  medical  college  have  ample  means 
of  judging,  and  but  too  often,  in  examining  the  wri- 
tings of  those  whom  they  instruct,  are  mortified  to 
observe  a  degree  of  carelessness,  not  to  say  ignorance 
in  composition,  which  is  unpardonable.     I  would  not 
dwell  upon  this  subjeet.     Arguments  are  not  neces- 
sary to  show  the  necessity  and  advantage  of  know- 
ing how  to  employ  our  own  language  correctly,  if  not 
elegantly.     The  public  always  expects  from  a  medi- 
cal man  who  aspires  to  any  degree  of  eminence,  a 
considerable  share  of  learning,  and  is  especially  indis- 
posed to  pardon  any  palpable  ignorance  of  his  own 
language. 

As  preparatory  to  the  study  of  medicine,  it  is  es- 
sential that  a  certain  amount  of  knowledge  of  natural 
philosojihy  be  attained ;  and  it  is  desirable  that  this 
knowledge  should  precede  that  which  is  more  strict- 
ly professional.  Without  it,  it  is  impossible  for  the 
student  to  comprehend  the  language  which  is  con- 


19 

stantly  employed  in  explaining  the  phenomena  of 
chemistry,  of  anatomy,  and  of  physiology.  How  can 
he  understand  the  action  of  the  muscular  system,  or 
the  no  less  remarkable  wisdom  displayed  in  the  hu- 
manjskeleton— the  frame-work  of  the  body — without 
some  knowledge  of  mechanics ;  the  functions  of  the 
lungs,  heart  and  blood-vessels,  without  that  of  pneu- 
matics and  hydrostatics ;  the  structure  and  uses  of 
the  eye,  unless  he  know  the  truths  taught  by  the 
science  of  optics.  We  may,  it  is  true,  treat  the  dis- 
eases of  all  these  parts  without  any  knowledge  of 
physics ;  but  we  must  treat  them,  to  a  certain  extent, 
empirically,  and  without  well  understanding  what 
we  do.  And  we  can  go  no  farther.  If  we  confine 
our  studies  to  merely  what  is  absolutely  essential  to 
make  us  practitioners  of  medicine,  we  must  be  con- 
tent to  take  our  science  as  we  find  it,  without  any 
prospect  of  adding,  by  our  own  observations  and  rea- 
soning, any  thing  to  the  common  stock  committed  to 
us  along  with  our  contemporaries. 

Nor,  for  similar  reasons,  can  we  dispense  with 
some  knowledge  of  Natural  History  ;  of  Mineralogy, 
Botany  and  Zoology,  the  sciences  which  teach  us 
the  structure  and  properties  of  the  three  great  classes 
of  material  substances,  as  they  exhibit  themselves  in 
the  Mineral,  Vegetable,  and  Animal  kingdoms  of  na- 


20 

ture.  From  all  these  are  the  substances  derived 
which  go  to  form  the  Materia  Medica,  but  especially 
is  Botany  essential  to  the  physician,  as  by  far  the 
largest  number  of  these  substances  are  of  vegetable 
origin. 

The  Fine  Arts  may  be  made  subsidiary  to  our 
profession.     The  physician  who  is  so  fortunate  as  to 
have  a  talent  for  draioing,  may  consider  himself  the 
possessor  of  a  most  valuable  gift,  and  should  never 
fail  to  cultivate  it.     But,  even  without  any  decided 
bent  for  this  beautiful  accomplishment,  you  may  all 
acquire  sufficient  skill  to  copy  valuable  drawings  or 
plates,  which  you  may  not  have  the  means  of  pur- 
chasing ;  or  still  more  usefully  to  delineate  the  ap- 
pearances of  disease,  as  you  may  find  them  in  pa- 
tients during  life,  or  in  examining  their  bodies  after 
death.     Not  a  few  of  the  most  valuable  works  we 
possess  in  every  department  of  medicine  are  illustrat- 
ed by  drawings  executed  by  their  authors ;  and  no 
other  artist  can  make  such  drawings  so  well  for 
these  purposes,   as   he  who  fully  understands   the 
structure  or  the  disease  which  he  intends  to  deli- 
neate. 

Such  are  the  principal  branches  of  education  which 
should  be  preliminary  to  the  study  of  medicine  ;  and, 
numerous  as  they  may  appear,  when  thus  collected 


21 

together,  every  one  of  you,  gentlemen,  lias  had  ample 
time  to  have  acquired  them,  if  you  have  employed 
that  time  to  the  best  advantage.  Not  that  I  would 
discourage  those  who  have  not  had  the  means  of  ob- 
taining such  an  education  ;  or,  having  the  advantages, 
have  not  improved  them.  You  cannot  make  up  for 
all  the  time  you  have  lost ;  but  you  may  accomplish 
much  by  using  what  remains.  Nor  is  all  this  know- 
ledge absolutely  essential.  With  it,  you  will  pursue 
your  professional  education  with  comparative  ease 
and  rapidity.  Without  it,  you  may  still  become 
good  physicians,  and  even  attain  a  high  rank  in  the 
profession ;  but  you  will  take  each  step,  as  you  ad- 
vance in  knowledge,  with  more  labor  and  difficulty  ; 
and  you  cannot  add  the  reputation  of  learning  to  that 
of  usefulness. 

Let  me  next  call  your  attention  to  the  more  strict- 
ly professional  studies,  which  you  are  here  assembled 
to  commence  or  continue.  Of  these,  of  course,  the 
ground-work  is  Anatomy.  It  is  hardly  necessary  to 
say  to  you,  that  with  this  you  must  begin.  Before 
you  understand  the  structure  of  the  human  body, 
you  cannot  possibly  comprehend  its  diseases;  and 
you  cannot  too  minutely  investigate  and  learn  every 
part  of  this  beautiful  and  complicated  machine.  Lec- 
tures on  Descriptive  Anatomy  afford  the  easiest  and 


22 

"best  method  of  gaining  a  general  idea  of  the  human 
body ;  and  these  must  first  receive  your  attention. 
But  Anatomy  cannot  be  learned  either  from  Lectures 
or  Books  alone.  It  is  alone  by  Dissections ;  by  ex- 
amining for  yourselves  each  particular  part  of  the 
body ;  by  patiently  and  carefully  separating  each 
part  from  these  around  it,  and  thus  learning  its  exact 
position  and  relation  to  all  the  rest,  as  well  as  its  more 
minute  structure ;  it  is  alone  by  slowly  and  labori- 
ously pursuing  this  method  of  inquiry  that  you  can 
ever  become  anatomists. 

It  would  hardly  seem  necessary  to  prove  the  value 
of  dissections  to  the  students  of  medicine ;  nor  would 
any  one  have  the  hardihood  to  deny  the  absolute  ne- 
cessity of  this  pursuit  both  to  the  physician  and  sur- 
geon. And  yet,  practically,  it  is  denied,  and  that  by 
a  very  large  number  of  those  who  are  every  year  en- 
tering our  profession.  Where  do  the  students,  who 
attend  medical  lectures,  in  small  towns  in  the  inte- 
rior, obtain  the  means  of  dissection.  It  is  notorious 
that  they  have  them  not  at  all ;  and  yet  such  schools 
do  exist  in  every  part  of  this  section  of  the  Union, 
where  Anatomy  is  attempted  to  be  taught  merely 
through  the  medium  of  the  eyes  and  ears,  by  Lec- 
tures and  Demonstrations.  And  still  worse  is  it  a 
notorious  fact,  and  especially  in  our  own  State,  that 


23 

great  numbers  become  legal  practitioners  without  at- 
tending a  single  medical  lecture ;  not  only  without 
having  dissected  human  bodies  themselves,  but  with- 
out ever  having  seen  these  dissections  made  by 
others.  This  is  the  result  of  the  very  imperfect  me- 
dical laws  of  this  state.  Every  medical  society  in 
the  state,  and  they  are  as  numerous  as  the  coimties, 
has  the  same  legal  right  to  grant  a  license  to  prac- 
tise physic  as  the  colleges  ;  and  to  obtain  this  license, 
the  student  is  not  required  to  attend  a  single  medi- 
cal lecture,  nor  to  have  dissected  a  single  human 
body.  And  such  licenses  are  granted  in  numbers, 
and  the  state  is  thus  filled  with  practitioners  of  me- 
dicine utterly  unfit  for  their  professional  duties. 

But  to  return  to  the  subject  of  medical  studies.  A 
knowledge  of  anatomy  is  incomplete  without  that  of 
Physiology.  By  the  one  you  learn  the  structure,  by 
the  other  you  ascertain  the  functions  of  the  different 
parts  of  the  human  body  ;  and  in  pursuing  the  inter- 
esting inquiries  in  which  this  last  is  constantly  en- 
gaged, you  are  abundantly  compensated  for  the 
more  dry  and  laborious  pursuit  of  descriptive  Ana- 
tomy. 

Along  with  Anatomy  and  Physiology,  one  of  your 
earliest  pursuits  must  be  the  study  of  Chemistry. 
By  its  means  we  learn  the  ultimate  constitution  of 


24 

the  different  substances,  of  which  our  bodies  consist : 
that  of  the  different  substances,  which  have  relation 
to,  or  act  upon  these  bodies  ;  and  the  changes  and  re- 
sults produced  by  these  actions.  By  Chemistry,  too, 
we  learn  the  nature  of  the  various  medicines  we 
employ  for  the  cure  of  diseases,  and  the  mode  of  pre- 
paring them.  By  its  aid,  we  know  how  to  combine 
these  medicines  without  destroying  their  effects  by 
mutual  decomposition ;  we  judge  of  their  purity,  and 
detect  the  adulterations  so  frequently  made  in  them. 
By  means  of  Chemistry,  new  principles  are  detected 
in  various  substances,  which  prove  most  valuable 
medicines ;  and  of  those  long  used,  and  of  well  as- 
certained value,  the  active  parts  are  distinguished 
and  separated,  while  the  useless  and  more  bulky  ones 
are  rejected.  Chemistry,  then,  is  indispensable  to  us, 
and  a  knowledge  of  its  truths  must  be  early  acquir- 
ed. It  is  one  of  the  subjects  which  must  first  engage 
the  attention  of  the  student  of  medicine. 

The  first  practical  branch  which  it  is  necessary  to 
learn  is  Surgery ;  and  its  study  may  be  advanta- 
geously commenced  at  the  same  time  with  those  we 
have  already  mentioned.  The  principles  of  Surgery 
lie  at  the  foundation  of  all  medicine,  and  they  are 
comparatively  few  and  more  simple  than  those  of 
the  practice  of  physic.     Without  a  knowledge  of 


25 

surgery,  we  can  never  become  physicians  ;  and  even 
although  we  may  never  intend  to  practise  it?  we  must 
become  well  acquainted  with  the  one,  to  give  us  a 
full  understanding  of  the  other.  In  dwelling  upon 
the  necessity  of  surgery  to  the  physician,  Sir  Astley 
Cooper  always  used  to  point  to  the  example  of  Dr. 
Baillie,  who  held  the  very  first  rank  of  the  physicians 
of  his  day.  This  distinguished  man  was  educated 
for  a  surgeon,  and  began  the  practice  of  this  branch 
exclusively.  It  was  only  afterwards  that  he  gave 
his  attention  to  medicine,  and  gradually  became  so 
much  engaged  in  it,  that  he  gave  up  surgery  entire- 
ly, and,  practising  solely  as  a  physician,  gained  the 
high  reputation,  which  ceased  not  with  his  life. 

Along  with  an  attendance  upon  Lectures  on  Sur- 
gery, the  students  cannot  too  soon  begin  to  observe 
its  practice  ;  and  indeed  the  same  remark  is  equally 
applicable  to  medicine.  For  this  he  can  be  at  no 
loss  for  opportunities,  with  the  Hospital,  Infirmaries 
and  Dispensaries  always  open  to  him ;  besides  the 
frequent  occasions  in  the  private  practice  of  their 
seniors,  of  which  attentive  pupils  can  always  avail 
themselves.  He  should  make  himself,  at  the  very 
outset  of  his  studies,  familiar  with  diseases  and  their 
modes  of  cure ;  for  the  very  same  reason  that  many 
teachers  of  modern  languages  make  their  pupils  learn 

4 


26 

words  and  phrases  before  they  teach  them  grammar. 
By  this  means  he  will  the  more  easily  understand  the 
pathological  principles  which  he  hears  in  the  lecture 
room  ;  and  what  he  hears,  will  afford  him  much  more 
interest.  How,  if  he  pursue  a  different  course,  will 
he  comprehend  the  theory  of  inflammation  or  suppura- 
tion, if  he  have  never  seen  a  phlegmon  or  an  abscess'? 
How  little  impression  will  be  made  upon  his  under- 
standing by  the  most  accurate  account  of  the  varie- 
ties of  the  pulse,  if  he  have  never  himself  felt  the 
pulse  of  the  sick. 

For  similar  reasons,  the  student  should  immediately 
avail  himself  of  every  opportunity  of  performing  all 
the  minor  operations,  and  the  many  offices  about  the 
the  sick  which  are  incessantly  recurring  in  ordinary 
practice.  He  should  know  how  to  do  all  these 
things  himself,  even  although  in  after-life  he  may 
only  have  to  direct  them  to  be  done  by  others.  He 
should  know  how  to  bleed,  to  apply  leeches  or  cup- 
ping glasses,  to  make  an  issue  or  a  seton,  apply  and 
dress  a  blister  or  a  sinapism. ;  and  so  of  numerous  other 
of  the  more  common  and  simple  duties  of  those  who 
minister  to  the  sick.  These  things  cannot  be  done 
too  often  nor  begun  too  early ;  for,  simple  as  many  of 
them  are,  they  are  never  done  perfectly  well  by  him 
who  has  not  done  them  frequently.     In  performing 


27 

them,  habits  of  neatness  and  accuracy  should  be  cul- 
tivated ;  for  upon  attention  to  these  things  does  the 
comfort  of  many  a  patient  depend.  A  clumsy  ope- 
rator will  cover  his  patient  with  blood  in  the  com- 
mon operation  of  opening  a  vein,  while  a  skilful  one 
will  hardly  let  fall  a  drop.     And  so  of  all  the  rest. 

The  subjects  which  I  have  thus  far  enumerated,  are 
abundantly  sufficient  to  occupy  the  student  during 
his  first  year  ;  and  those  who  will  have  an  opportuni- 
ty of  attending  lectures  for  several  successive  winters, 
will  do  well  to  confine  themselves  to  these  subjects 
during  their  first  course  of  Lectures. 

The  precise  order  in  which  other  branches  are  ta- 
ken up  is  not  so  material  as  that  of  those  I  have  thus 
far  spoken  of.  One  of  the  next  to  be  learned  is  Ma- 
teria Medica.  This  science  treats  of  the  properties 
of  the  various  agents  we  employ  in  the  treatment  of 
diseases  ;  the  art  of  pharmacy,  by  which  they  are  ob- 
tained from  their  various  sources  in  nature,  and  pre- 
pared for  administration ;  and  therapeutics,  which  ex- 
plains their  modes  of  action  on  the  living  body.  Its 
importance  and  direct  application  to  practice  is  suf- 
ficiently obvious.  And  here,  too,  the  student  will  do 
well  to  use  every  means  of  gaining  knowledge  by  his 
own  experience.  He  cannot  too  soon  engage  in  prepar- 
ing medicines  for  administration.   He  thus  becomes 


28 

familiar  with  the  substances  he  is  afterwards  to 
prescribe;  he  learns  the  modes  of  detecting  their 
adulterations  and  impurities;  and  he  employs  the 
very  best  method  of  ascertaining  and  fixing  in  his 
memory  their  doses.  There  is  no  part  of  the  educa- 
tion of  students  of  medicine  more  neglected  than 
this  ;  and  I  believe  it  is  not  very  uncommon  for  gen- 
tlemen to  graduate,  who  have  never  prepared  a  dose 
of  medicine,  nor  seen,  except  in  the  Lecture  Room, 
half  of  the  more  common  substances  employed  as  re- 
medies. It  is,  on  this  account,  almost  to  be  regret- 
ted, that  the  old  practice,  in  this  city,  of  physicians 
dispensing  their  own  medicines,  has  fallen  into  dis- 
use. Their  pupils  lose  an  advantage  which  they 
can  in  no  other  way  obtain.  I  have  always  felt  that 
the  time  which  I  spent,  when  a  student,  in  preparing 
the  medicines  for  the  patients  of  my  instructor,  was 
as  usefully  employed  as  any  which  was  devoted  to 
my  medical  education. 

The  Theory  and  Practice  of  Physic,  and  Obstetric 
Medicine,  are  the  subjects  next  in  order  in  the  studies 
of  the  diligent  pupil.  By  these  he  is  introduced  to 
what  is  to  be  the  business  of  his  life.  It  is  no  longer 
preliminary  study,  or  subsidiary  branches  of  know- 
ledge, which  must  engage  his  attention ;  but  it  is 
the  direct  management  of  disease  which  he  is  now 


29 

to  learn ;  and  he  will  not  find  that  all  the  time  that 
he  can  devote  to  them,  will  be  more  than  sufficient 
to  give  him  the  knowledge  he  requires. 

As  a  means  of  illustrating  what  is  learned  on  the 
nature  and  effects  of  disease  in  the  human  body,  it  is 
indispensable  that  a  fair  portion  of  time  be  devoted 
to  the  study  of  Morbid  Anatomy.  It  is  not  sufficient 
to  be  well  acquainted  with  the  healthy  structure  of 
every  part  of  the  human  body.  We  must  also  learn 
their  appearances  after  they  have  suffered  from  dis- 
ease. It  is  evident,  that  until  we  have  been  well  in- 
structed in  the  former  of  these  branches  of  know- 
ledge, we  can  never  make  progress  in  the  latter ;  or, 
in  other  words,  until  we  are  quite  familiar  with  the 
natural  appearances  of  every  part  of  the  body  we 
are  examining,  we  cannot  judge  of  what  is  preterna- 
tural. Certain  changes  take  place  after  death  as  a 
mere  consequence  of  dissolution,  and  independently 
of  any  previous  disease  ;  and  in  not  a  few  instances 
have  these  changes  been  mistaken  for  morbid  ap- 
pearances. In  studying  Morbid  Anatomy,  then,  we 
must  understand,  first,  the  healthy  structure  of  parts ; 
secondly,  the  changes  which  occur  spontaneously  in 
the  body  after  death ;  and  lastly,  the  effects  of  dis- 
ease. And,  still  farther  ;  in  examining  appearances 
evidently  morbid,  we  must  distinguish  between  those 


30 

which  essentially  belong  to  the  disease  of  which  the 
patient  died,  originating  with  it ;  and  others  which 
may  be  termed  incidental,  and  the  mere  result  of 
long-continued  morbid  action  going  on  in  the  system. 
By  mistaking  the  latter  for  the  essential  appearances 
belonging  to  the  disease  which  destroyed  the  patient, 
we  may  err  widely  in  reasoning  on  his  case.     This 
science  then  is  by  no  means  easy  of  attainment,  and 
even  with  the  valuable  aid  to  be  derived  from  Lec- 
tures and  preparations,  will  require  careful  study  for 
its   acquisition.      Neither   student   nor  practitioner 
should  ever  cease  to  pursue  it,  and  should  omit  no 
opportunity  of  examining  bodies  whenever  they  oc- 
cur.     And  such  opportunities  will,   if  sought   for, 
prove   more   frequent   than   is  generally   imagined. 
Abhorrent  as  is  the  mutilation  of  the  human  body  to 
the  feelings  of  every  surviving  friend,  you  will  find 
few  who  will  resist  an  appeal  to  their  reason  and 
good  sense  in  cases  where  an  autopsic  examination 
is,  from  any  cause,  deemed  desirable.     Even  among 
people  of  the  least  education,  I  have  rarely  had  such 
opportunities  refused ;  and  from  my  own  experience, 
I  can  assure  you  that  you  never  need  hesitate  in  any 
case  to  ask  such  permission,  and  it  will  very  rarely 
be  denied. 

It  is  not  until  each  of  the  branches  to  which  I  have 


31 


alluded  has  been  in  a  good  degree  acquired,  that  a 
student  is  prepared  to  comprehend  the  science  of 
Forensic  Medicine  •  and  he  would  therefore  do  well 
to  reserve  any  very  close  attention  to  this  subject  to 
the  later  periods  of  his  studies.  Its  objects  are  to 
teach  us  the  application  of  medical  knowledge  to 
various  questions  in  law,  which  are  incessantly  oc- 
curring in  civilized  society  ;  and  it  pre-supposes  an 
acquaintance  with  every  branch  of  our  science.  Its 
importance  is  now  so  generally  conceded,  that  I  need 
not  dwell  upon  it ;  and  I  feel  myself  the  less  called 
upon  do  so,  when  I  recollect  that  from  this  college, 
and  its  associate  in  the  State  University,  has  emanated 
the  best  work  on  Legal  Medicine  which  is  found  in 
our  lanoruaore.* 

These,  gentlemen,  are  the  several  elementary 
branches  of  medical  science  which  it  is  our  province 
to  teach  and  your  business  to  learn.  But  you  must 
not  suppose,  that  even  after  you  have  diligently  at- 
tended lectures  on  each  of  these  subjects,  and  care- 
fully read  numerous  works  relating  to  them,  you  are 
thereby  prepared  successfully  to  practise  medicine, 
and  to  combat  disease  in  all  the  protean  varieties 
in  which  you  may  one  day  expect  to  meet  with  it. 

*  Elements  of  Medical  Jurisprudence,  by  Theodrick  Remeyn  Beck,  M.  D., 
and  John  B.  Beck,  M.  D. 


32 

You  must  not  only  have  all  this  knowledge,  but  you 
must  know  how  to  use  it ;  and  you  will  find  in  your 
future  acquaintance  with  medical  men,  that  it  is  not 
always  he  who  possesses  the  most  medical  knowledge, 
who  can  avail  himself  of  it  to  the  best  advantage.  In- 
deed, you  will  meet  with  not  a  few  instances  to  prove 
to  you,  that  one  man,  with  a  very  small  amount  of 
knowledge,  may  use  it, — may  apply  it  to  so  much  bet- 
ter advantage,  than  another  who  far  excels  him  in 
science,  as  to  render  him  the  most  really  useful 
practitioner. 

Difficult,  then,  as  is  the  acquisition  of  learning,  its 
application  will  prove  more  so  ;  and  unless  we  em- 
ploy every  means  of  acquiring  the  one,  the  other  will 
prove  of  little  value  to  us.  This  power  is  to  be 
gained  by  using  every  opportunity  of  employing  the 
knowledge  we  have  obtained  at  the  bedside  of  the 
sick.  Your  first  experiments  in  examining  disease, 
will  be  little  satisfactory  to  you  ;  and  your  very  ill 
success  will  prove  to  you  how  much  you  must  ob- 
serve for  yourselves,  in  order  to  distinguish  between 
diseases,  as  you  will  meet  with  them  in  real  life,  not 
in  lectures  nor  in  books.  It  is  this  which  makes 
attendance  at  Hospitals  and  Infirmaries  an  essential 
part  of  medical  education  ;  and  it  is  a  matter  of  con- 
gratulation to  you  all,  that  you  will  no  where  meet 


with  a  better  hospital  than  that  of  this  city.  It  is 
this  which  makes  Clinical  Lectures  within  the 
walls  of  an  hospital  so  valuable ;  and  whether  these 
Lectures  are  given  in  form  in  a  theatre,  or  whether 
they  consist  in  familiar  remark  at  the  bedside  itself, 
they  are  of  importance  second  to  nothing  else  that 
you  will  be  taught.  You  will  have  the  advantage 
of  both  these  modes  of  instruction ;  and  if  you  use 
these  advantages  as  zealously  as  they  deserve,  it 
will  depend  upon  yourselves  alone,  whether  or  not 
you  become  useful  and  skilful  practitioners  as  well  as 
learned  physicians.  I  have  advised  you,  at  the  very 
outset  of  your  medical  studies,  to  familiarize  your- 
selves with  disease  and  its  modes  of  treatment ;  and  I 
cannot  do  better  than  to  repeat  the  same  advice  as  to 
the  last  subject  which  should  engage  you  while  you 
are  still  only  students.  At  first  you  will  not  be  pre- 
pared to  understand  Clinical  Lectures ;  but  you 
may  constantly  gain  information  by  frequenting  the 
wards  of  an  Hospital ;  while,  later  in  your  pupilage, 
you  will  find  these  Lectures  admirably  to  illustrate 
all  that  you  have  been  previously  taught.  They 
will  prove  to  be  the  best  possible  means  of  preparing 
you  for  engaging  yourselves  in  the  treatment  of 
disease. 
There  are  also  particular  branches  of  Medicine  and 

5 


34 

Surgery,  which,  if  we  would  become  masters  of 
them,  require  more  minute  attention  than  is  afforded 
in  ordinary  systematic  lectures  and  at  general  hos- 
pitals. Diseases  of  the  Eye,  of  the  Ear,  the  Lungs, 
the  Skin,  and  several  others,  are  now  taught  and  stu- 
died as  distinct  branches  of  medical  science ;  and 
ample  opportunities  are  afforded  in  this  city  for  their 
prosecution.  The  New-York  Eye  Infirmary,  with 
its  1200  patients  a  year,  gives  abundant  means  of 
observing  every  variety  of  disease  to  which  the  eye 
and  ear  are  subject.  It  has  now  been  established 
nearly  twenty  years,  and  its  usefulness,  in  teaching  as 
well  as  treating  disease,  is  fully  acknowledged.  More 
recently  institutions  have  appeared  for  treating  Dis- 
eases of  the  Lungs  and  the  Skin  ;  and  courses  of  Lec- 
tures have  been  given  on  these  subjects ;  and  it  is 
much  to  be  desired  that  those  who  are  thus  engaged 
should  persevere  in  objects  by  which  they  will  not 
only  advance  their  own  reputation,  but  do  vast  good 
by  relieving  the  sufferings  and  diseases  of  the  poor, 
and  instructing  the  younger  members  of  their  own 
profession. 

Having  thus,  gentlemen,  passed  in  rapid  review 
the  several  subjects  which  must  engage  you  as  stu- 
dents of  medicine,  and  pointed  out  the  order  in  which 
you  should  take  them  up,  let  me  close  these  remarks 


35 


by  calling  your  attention  for  a  moment  to  the  de- 
partment of  medicine  which  it  is  my  duty  to  teach  in 
the  ensuing  course  of  Lectures.  You  will  find,  that 
to  understand  Midwifery,  and  the  treatment  of  the 
Diseases  of  Women  and  Children,  you  can  dispense 
with  no  part  of  the  knowledge  which  I  have  declared 
essential  to  the  accomplished  physician.  You  will 
find  that  the  practitioner  of  Midwifery  requires  to  be 
equally  a  physician  and  a  surgeon.  If  he  be  educat- 
ed exclusively  for  either  one  or  the  other  of  these 
branches  of  the  healing  art,  he  must  necessarily  be 
incompetent  to  practise  Midwifery.  He  must  be  a 
physician ;  for  he  is  daily  called  upon  to  treat  many 
of  the  most  important,  most  dangerous,  and  most 
obscure  diseases.  He  must  be  a  surgeon ;  for  he  has 
operations  to  perform  requiring  all  the  surgeon's 
skill.  He  must  have  an  exact  knowledge  of  the  ana- 
tomy of  the  parts  which  are  the  subject  of  operation ; 
great  dexterity,  and  such  as  is  only  acquired  by  re- 
peated practice  ;  great  resolution  and  perseverance ; 
for  without  these  he  never  can  accomplish  obstetric 
operations.  He  must  especially  have  remarkable 
presence  of  mind;  for  in  no  cases  is  he  more  frequently 
called  upon  than  in  obstetric  emergencies  to  relieve 
patients  from  the  dangers  arising  from  sudden  acci- 
dents ;  from  situations  in  which  death  is  imminent ; 


36 

and  when  the  terror  and  alarm  of  those  around  the 
patient,  as  well  as  her  immediate  danger,  leave  him 
entirely  dependent  upon  his  own  resources. 

Let  us  attempt  to  illustrate  these  propositions  by 
slightly  reviewing  some  of  the  cases  in  which  the  ob- 
stetric practitioner  is  called  upon,  and  thus  prove  the 
necessity  of  a  thorough  knowledge  of  both  medicine 
and  surgery. 

The  practitioner  of  Midwifery  must  be  a  physician. 
His  duty  is  to  treat  the  diseases  of  women  and  of 
children.  The  diseases  of  these  two  classes  of  per- 
sons furnish,  indeed,  the  principal  source  of  occupa- 
tion to  every  medical  man.  If  any  such,  engaged  in 
large  practice,  should  keep  a  register  of  all  the  cases 
he  treats  in  a  year,  he  would  perhaps  be  surprised 
to  find  how  constantly  he  has  been  occupied  with  the 
care  of  women  and  children,  and  in  how  comparative- 
ly small  a  number  of  instances  men  become  his  pa- 
tients. The  causes  acting  upon  the  health  of  fe- 
males, both  natural  and  accidental ;  arising  in  the 
one  case  from  the  peculiarities  in  her  constitution  by 
which  she  is  fitted  for  the  great  function  of  reproduc- 
ing her  species ;  and,  in  the  other,  from  errors  in  edu- 
cation, both  physical  and  moral,  and  the  usages  of 
society  which  more  constantly  are  influencing  the 
•habits  of  the  sex ; — these  causes  are  incessant  in  their 


37 

operation,  and  act  in  a  variety  of  modes,  which  are 
abundantly  competent  to  account  for  all  the  pheno- 
mena they  produce. 

The  generative  process,  as  far  as  it  is  performed 
by  men,  has  comparatively  slight  influence  upon 
their  health.  But  in  the  female,  its  performance 
brings  along  with  it  a  series  of  diseases  and  dangers, 
peculiar  to  the  sex,  which  entitle  her  to  our  warmest 
sympathies,  and  the  exercise  of  our  best  faculties  in 
devising  means  to  relieve  her  diseases  and  avert  her 
dangers.  How  large  a  portion  of  the  lives  of  most 
married  women  is  devoted  to  the  bearing  of  children. 
The  long  period  of  pregnancy,  during  which  she  of- 
ten suffers  from  a  variety  of  ailments,  in  themselves 
constituting  a  formidable  list  of  human  ills  ;  the  pro- 
cess of  childbirth,  attended,  as  it  always  is,  with 
intense  suffering,  and  often  with  dangers  of  the  most 
imminent  kind ;  the  period  of  recovery  from  this  state 
during  which  severe  maladies  originate,  which  may 
ever  after  impair  the  health  and  ruin  the  happiness 
of  the  poor  sufferer  ;  and  lastly,  the  whole  period  of 
lactation,  with  the  cares  and  anxieties  of  the  mother 
wTatching  over  her  infant ;  and  perhaps  worn  down 
at  last,  and  losing  her  health  in  the  very  effort  her 
constitution  makes  to  supply  nourishment  to  her  off- 
spring ;  how  many  of  the  best  days  of  our  mothers 


38 

are  thus  employed  !  And  when,  in  giving  birth  to  a 
numerous  progeny,  these  various  processes  are  re- 
peated again  and  again,  is  it  wonderful  that  women 
are  obliged  so  often  to  seek  the  advice  and  assistance 
of  physicians. 

Let  any  one  of  us  inquire  minutely  into  the  condi- 
tion of  health  of  any  number  of  females  of  our  ac- 
quaintance. We  shall  find,  that  if  we  discover  one  in- 
dividual of  the  weaker  sex  habitually  free  from  any 
kind  of  disorder  or  disease,  it  is  almost  an  exception 
to  a  general  law :  and  for  one  such  exception,  we 
meet  with  numerous  examples  of  women  habitually 
suffering  under  complaints,  often  slight,  often  serious, 
but  all  more  or  less  tending  to  impair  the  enjoyment 
of  life. 

They  share  with  the  other  sex  all  the  common 
diseases  incident  to  humanity.  The  numerous  de- 
rangements to  which  the  digestive  apparatus  is  sub- 
ject; the  less  frequent,  but  even  more  dangerous  dis- 
eases incident  to  the  lungs  and  other  respiratory  or- 
gans ;  the  whole  list  of  fevers  and  inflammatory  dis- 
eases which  are  every  day  calling  upon  us  for  relief ; 
all  these  and  many  others  are  equally  shared  by 
women  with  ourselves.  But  when,  besides  those 
already  adverted  to  as  incident  to  the  performance 
of  the  generative  function,  we  add  the  numerous  class 


39 


of  disorders  to  which  they  are  subject  from  a  more 
exquisitely  organized  nervous  system ;  how  largely 
do  they  bear  the  share  of  physical  ills  to  which  our 
race  is  subject.  The  other  peculiar  function  of  the 
female,  menstruation,  adds  still  more  to  the  catalogue 
of  diseases  she  has  to  suffer.  Many  young  females 
permanently  lose  their  health  by  the  constitution 
failing  in  the  effort  to  establish  this  function  ;  and  in 
after-life,  its  suppression  or  diminution,  or  its  occur- 
rence too  frequently  or  in  excess,  all  interfere  more 
or  less  with  the  health  ;  while  the  period  of  the  ces- 
sation of  the  menses,  although  perhaps  too  much 
dreaded  by  women  themselves,  is  justly  regarded  as 
often  developing  in  the  individual  new  and  formida- 
ble diseases,  peculiar  to  females,  and  to  that  particu- 
lar epoch  of  their  lives. 

In  males  there  is  no  analogous  cause  of  disorder 
to  the  health.  The  age  of  puberty,  with  boys,  is 
generally  one  of  uninterrupted  good  health ;  and  sub- 
ject to  none  of  the  disorders  which  in  the  other  sex 
are  constantly  exciting  the  solicitude  of  the  mother 
and  the  physician.  Nor  at  the  age  when  the  male 
loses  the  power  of  reproducing  his  species,  corre- 
sponding to  the  cessation  of  the  menses  in  the  female, 
is  there,  to  any  remarkable  extent,  a  peculiar  prone- 
ness  to  disease.     Indeed,  in  the  male  there  is   not, 


40 

as  in  the  female,  a  certain  age  when  the  generative 
powers  cease.  In  the  latter,  almost  uniformly,  the 
menses  cease  to  appear  between  the  fortieth  and 
fiftieth  year,  and  this  cessation  at  once  marks  and 
fixes  the  period  of  the  failure  of  the  generative 
powers.  In  males  it  is  not  so.  There  is  hardly  any 
age  which  can  be  assumed  as  being  the  limit  to  the 
generative  powers  of  men ;  and  so  well  established 
is  this  fact,  that  the  English  laws  allow  no  such  limit 
during  the  life  of  the  individual ;  while  examples  are 
well  authenticated  of  offspring  being  born  to  fathers 
of  an  age  approaching  the  extreme  verge  of  the  limit 
of  human  life. 

Such  are  some  of  the  causes  operating  upon  the 
health  of  females  to  produce  the  numerous  diseases 
to  which  they  are  subject ;  and  the  mere  enumera- 
tion of  them  would  abundantly  illustrate  the  neces- 
sity of  a  thorough  knowledge  of  medicine,  of  being  a 
good  physician,  for  every  individual  who  assumes  to 
himself  the  duties  of  a  practitioner  especially  devoted 
to  the  treatment  of  their  diseases. 

But  the  practitioner  of  Midwifery  must  also  be  a 
surgeon ;  he  must  be  an  anatomist ;  he  must  have 
skill,  resolution,  perseverance,  and  presence  of  mind. 
Let  any  one  of  you,  gentlemen,  attempt,  for  the  first 
time  in  your  lives,  in   a  case  of  labor,  where  the 


41 


shoulder  is  the  presenting  part,  to  turn  the  child  and 
deliver  by  the  feet.  Let  the  woman  have  been  in 
labor  several  days,  the  membranes  broken,  the  uterus 
strongly  contracted  upon  the  body  of  the  child ;  the 
patient  resisting  the  efforts  of  the  operator,  and  his 
progress  constantly  interrupted  by  the  renewed 
throes  of  labor.  Recollect,  under  all  these  circum- 
stances, the  value  of  the  life  which  is  at  stake — the 
wife  of  a  devoted  husband,  the  daughter  of  affection- 
ate parents,  the  mother  of  children,  whose  loss  can 
never  be  supplied  to  them ;— and  then,  without  know- 
ledge, without  dexterity,  without  resolution,  perse- 
verance, and  presence  of  mind,  attempt  the  operation, 
and  imagine  the  result. 

Or,  in  another  case,  where  the  child  is  born,  but 
the  placenta  undelivered  ;  sudden  hemorrhage  occurs, 
and  at  once  threatens  the  destruction  of  life  within  a 
time  so  short,  that  if  a  moment  be  lost  in  reflecting 
what  is  to  be  done,  death  is  at  hand.  We  see  the 
suddenly  pale  and  ghastly  countenance,  the  blanched 
and  death-like  color  of  the  lip, — we  hear  the  almost 
inaudible  voice  uttering  only  the  tones  of  delirium, 
and  observe  the  restless  tossing  to  and  fro  of  the  pa- 
tient, almost  ready  to  expire.  At  such  a  moment, 
imagine  yourselves,  gentlemen,  deficient  in  any  one 
of  the  points  I  have  suggested,  and  wanting  the  con= 

6 


42 


fidence  in  yourselves,  which  knowledge  and  skill 
alone  can  impire  ;  and  judge  how  unenviable  will  be 
your  feelings. 

Would  that  I  had  never  seen  the  results  of  such 
cases  when  managed  by  the  unskilful  and  the  igno- 
rant ;  and  worse  even  than  this,  the  destruction  of 
life  sometimes  produced  by  rash  and  barbarous  at- 
tempts at  effecting  artificial  delivery,  when  all  as- 
sistance was  entirely  unnecessary,  and  when  a  mere 
knowledge  of  the  powers  of  nature  alone  would  have 
produced  a  happy  result  simply  by  leaving  the  case 
to  itself.  In  witnessing  such  cases,  I  have  sometimes 
felt  that  more  than  a  doubt  existed,  whether  most 
good  or  evil  was  done  by  the  attendance  of  practi- 
tioners, taking  them  altogether,  male  and  female, 
skilful  and  ignorant,  upon  cases  of  labor ;  whe- 
ther the  lives  of  more  mothers  and  children  were  lost 
by  the  want  of  proper  assistance  rendered  in  due 
time,  or  by  improper  attempts  at  assistance  when  it 
was  not  required.  If  women  are  sometimes  suffered 
to  die  from  loss  of  blood,  with  the  placenta  undeli- 
vered, or  from  exhaustion  in  labor  resisted  by  some 
obstacle  which  the  natural  powers  cannot  over- 
come ;  so,  too,  their  lives  are  sometimes  destroyed  by 
rupture  of  the  uterus  in  forcible  and  unskilful  at- 
tempts to  deliver  the  placenta  or  turn  the  child  ; 


43 

from  lacerations  of  the  parts  by  instruments ;  or  the 
subsequent  occurrence  of  inflammation  and  slough- 
ing from  undue  violence,  either  manual  or  instru- 
mental. 

But  this  is  the  dark  side  of  the  picture.  Look  also 
at  the  other.  You  are  called  to  a  case  of  labor  pro- 
tracted by  some  obstacle  ;  in  which  the  patient  is 
almost  worn  out  with  exhaustion,  and  she  and  those 
around  already  despair  of  a  happy  result ;  in  which 
hours,  or  even  days  have  elapsed  in  unavailing  strug- 
gles; and  perhaps  unsuccessful  attempts  have  al- 
ready been  made  by  others  to  effect  the  delivery. 
You  find  the  case  within  the  reach  of  art,  and,  confi- 
ding in  yourselves,  you  at  once  apply  the  appropri- 
ate remedy,  and  save  both  the  mother  and  the  child. 
By  a  dextrous  application  of  the  forceps  in  one  case, 
or  by  means  of  the  hand  altering  the  position  of  the 
foetus  in  another,  you  remove  the  cause  of  delay  and 
finish  the  delivery.  The  sudden  revulsion  of  feeling 
of  the  desperate  patient,  and  the  no  less  despairing 
friends ;  the  expressions  of  gratitude  she  and  they 
pour  forth ;  the  eloquent  countenances  of  the  hus- 
band and  the  mother,  depicting  what  in  language 
they  cannot  utter :  these,  gentlemen,  are  rewards 
which  are  sufficient;  that  will  amply  repay  you 
for  all  the  time,  all  the  labor,  all  the  expense  you 


44 


may  have  bestowed  in  acquiring  the  knowledge 
and  skill  which  will  enable  you  to  produce  such  re- 
sults. 


ERRATA. 

Page  3.  In  the  names  of  the  Committee,  for  T.  M.  Halstead,  read 

T.  M.  Hoisted. 
Page  22,  line  7,  for  these,  read  those. 

"       "  13,    "  students,  read  student. 

"       "  20,  after  the  word  dissection  insert  an  interrogation  (?)* 

25,     u  16,  for  students,  read  student. 

36,     "     1,   "  and  when,  read  and  where. 


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' 


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c.l. 


tf  6  COLLECTION 

a./ 


